What is the difference between cryoprecipitate and Fresh Frozen Plasma (FFP)?

Difference Between Cryoprecipitate and Fresh Frozen Plasma

Cryoprecipitate is a concentrated plasma product derived from FFP that contains high levels of fibrinogen, Factor VIII, von Willebrand factor, Factor XIII, and fibronectin, while FFP contains all coagulation factors in their normal plasma concentrations but is much more dilute. 1

Composition and Preparation

Cryoprecipitate:

• Produced by slowly thawing FFP at 1-6°C, which causes high-molecular-weight proteins to precipitate 1, 2
• Contains concentrated amounts of: fibrinogen (400-450 mg per unit), Factor VIII, von Willebrand factor, Factor XIII, and fibronectin 1
• Available as single units (20-40 mL) or pooled bags of five units (100-200 mL) containing at least 2 g fibrinogen 1
• Approximately 9-fold enrichment of von Willebrand factor compared to FFP 3

Fresh Frozen Plasma:

• Contains all soluble coagulation factors at their normal plasma concentrations 1
• Approximately 300 mL volume per bag 4
• Must be frozen at -25°C or below to preserve labile factors V and VIII 4
• Once thawed, can be stored at 4°C for up to 24 hours (extended to 5 days for trauma-related major hemorrhage) 4

Primary Clinical Indications

Cryoprecipitate is specifically indicated for:

• Hypofibrinogenemia with fibrinogen <1.5 g/L during major hemorrhage (maintain >2 g/L in obstetric hemorrhage) 1
• Fibrinogen <1 g/L with significant bleeding risk before procedures 1
• Massive transfusion when fibrinogen cannot be measured timely 1
• Bleeding associated with thrombolytic therapy 1
• Disseminated intravascular coagulation with fibrinogen <1.0 g/L 1

FFP is primarily indicated for:

• Major hemorrhage requiring balanced ratio with RBCs (typically 1:1 or 1:1.5) until coagulation results available 1
• Correction of multiple coagulation factor deficiencies when PT >1.5 times normal, INR >2.0, or aPTT >2 times normal 1
• Urgent warfarin reversal with active bleeding when prothrombin complex concentrates unavailable 1
• Disseminated intravascular coagulation with bleeding or high bleeding risk 1
• Replacement fluid for therapeutic plasma exchange in thrombotic thrombocytopenic purpura 1

Key Practical Differences

Volume and Dosing:

• Cryoprecipitate: Adult dose is two pools (10 units total), providing concentrated fibrinogen replacement in small volume 1
• FFP: Therapeutic dose is 15 mL/kg to achieve minimum 30% plasma factor concentration 1, 4

Storage After Thawing:

• Cryoprecipitate: Can be kept at ambient temperature for 4 hours after thawing, should not be refrigerated again 1
• FFP: Can be stored at 4°C for up to 24 hours after thawing, must be used within 30 minutes once removed from refrigeration 4

Blood Group Compatibility:

• Both require ABO-compatible transfusion 1, 4
• If blood group unknown, use group AB FFP (contains no anti-A or anti-B antibodies) 4
• Group O components should only be given to group O recipients 1

Critical Clinical Pitfall

FFP should NOT be used:

• Simply to correct abnormal coagulation tests (PT, aPTT) in non-bleeding, hemodynamically stable critically ill patients, as these tests poorly predict bleeding risk 1
• Solely for volume replacement 1
• Prophylactically before low-risk procedures in stable patients with isolated coagulation abnormalities 1
• In elective cardiac surgery prophylactically 1

Cryoprecipitate is rarely indicated:

• When fibrinogen concentration is >150 mg/dL in non-pregnant patients 1
• For treatment of von Willebrand disease or hemophilia A when specific factor concentrates or recombinant products are available 1, 2

Factor XIII Content Consideration

Contrary to what might be expected, Factor XIII is only mildly enriched in cryoprecipitate (approximately 2-3 fold) compared to FFP, with FFP containing substantially more total Factor XIII per bag (288 U vs 60 U) 3. When Factor XIII replacement is the primary goal and volume is not a constraint, FFP may be preferred if specific Factor XIII concentrates are unavailable 3.